CERT Review Results
To obtain the results of your Comprehensive Error Rate Testing (CERT) review(s), please contact WPS Government Health Administrators at the following email address: CERTPartB@wpsic.com
We have seen increased denials and rejections based on the ICD-10 codes. Help us to process your claims appropriately. Only submit an ICD-10 code on the paper form once in Item 21 even if it applies to multiple lines of service. Use Item 24E to point at the specific diagnosis code in Item 21. Submission of a paper claim requires the fields to be completed correctly. Submission of ICD-10 codes in item 21 starting in section B or not going in order from A to L will cause a denial or rejection of your claim. More information can be found in the CMS Internet Only-Manual (IOM) Publication 100-04, Chapter 26.
Documentation for Appeals
When you need to submit medical record documentation with your appeal, include all pertinent documentation. The documentation should include the medical record detailing the service and the medical necessity of the service in question. In addition, providers should supply a separate statement indicating the specific information to evaluate in the medical record that supports the rationale for the appeal. This will help to ensure accurate, timely processing of your appeal.
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